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Publisher: Miami Breast Center
We undertook this prospective study to determine the effect of BRAVA breast expansion on breast augmentation with liposuctioned fat grafts and to establish the safety and efficacy of the procedure.
Methods: 50 women (age 17–63) underwent 55 fat grafting procedures on 97 breasts (3 unilateral, 5 women grafted twice). To prepare the recipient breast, they wore 10 hours/day for four weeks the BRAVA device, a bra-like external tissue expander shown to enlarge breast volume and to increase its blood flow. Using 2.7mm, 12 side holes cannulas and 300mm/Hg syringe vacuum, we harvested 250ml of fat per side (range 90 – 450ml). The fat was separated by sedimentation and diffusely re-injected into the breasts through 10 – 14 needle puncture sites in a three dimensional fanning pattern, micro-weaving the grafts using 2.4 mm cannulas and meticulously avoiding localized collections.
Twelve hours post-procedure, they resumed BRAVA wear and used it as a stent as much as possible during the first week tapering the wear down over the next few weeks. All patients had a baseline MRI of the breast; the first 23 had an MRI 3months post grafting, and all had another MRI at 6 – 12 months. A mammogram was obtained one year post grafting in women over forty. Breast volumes were derived from 3D volumetric reconstruction of the MRI scans. Follow up ranges from 5 years to 9 months (Average 3 years).
Results: Average augmentation volume was 230 ml/breast (90ml – 360ml). Graft survival averaged 90% (70% – 120%). There was a direct correlation and a linear dose response curve (R2=0.8) between pre-grafting expansion volume achieved with BRAVA and resultant final breast volume augmentation. The grafted fat appeared normal on MRI and on long-term follow up its volume changed with BMI fluctuations confirming normal metabolic activity. As we refined the surgical technique, operating time for bilateral augmentation was reduced from 5 to 1.5hrs. Patients returned to their normal activities within 3-4 days. MRI Breast volume measurements were unchanged between the 3 and 6 months studies (p>0.2). Thus the 3month MRI was discontinued for the remainder of the study.
Patients were all pleased with the natural feel and shape of their enlarged breasts and the improved appearance of the liposuctioned donor sites. There were no suspicious breast masses or nodules. MRI recognized an 18% incidence of fat necrosis and the one-year mammogram identified them all. More importantly, the radiologist had no difficulty interpreting the studies. The only complication was a transient low-grade infection in a woman with asymmetry and pectus who had extensive grafting of the breast parenchyma.
Conclusions: Aesthetically pleasing natural breast augmentation can be achieved with fat grafts obtained by gentle liposuction. The most important determinant of final augmentation volume is the extent of breast expansion achieved with BRAVA prior to fat grafting. Atraumatic low pressure harvesting with fine cannulas, minimal fat manipulation, and diffuse periglandular graft placement as microdroplets through multiple injection ports in a pre-expanded, hypervascular bed can achieve excellent long term survival of very large graft volumes. Fat necrosis is a rare event that is recognizable by modern breast imaging techniques. The procedure is safe and effective and did not create lesions that might interfere with cancer detection.